Patient-Centered Medical Homes: The Path Forward
<p>The present and future of the patient-centered medical home (PCMH) model of primary care is explored in depth in the June issue of the <em>Journal of General Internal Medicine</em>. In a series of articles written with support from The Commonwealth Fund, the Agency for Healthcare Research and Quality, and the American Board of Internal Medicine Foundation, leading researchers and thought leaders discuss the key issues that need to be resolved if the PCMH is to gain wider currency in U.S. primary care.</p>
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<a href="http://www.commonwealthfund.org/~/media/03eca7b6b32c461da8caaa2358143bf…;
<strong>A Nationwide Survey of Patient-Centered Medical Home Demonstration Projects</strong> </a> <br />In interviews with leaders at 26 demonstration sites around the country where the PCMH is being pilot-tested, researchers Asaf Bitton, Carina Martin, and Bruce E. Landon found substantial diversity in terms of size, scope, and design. Most of the projects use a payment approach that combines fee-for-service payments with a fixed, monthly case management fee and bonuses based on clinical performance. The authors say this diversity "suggests an urgent need to incorporate evaluation in programs' designs" to determine the impact on costs and utilization, quality of care, and physician and staff experiences.</p>
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<a href="http://www.commonwealthfund.org/~/media/6e687994e52e4c089557a1fe2b46795…;
<strong>How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?</strong> </a> <br />For a primary care practice to become a medical home, radical changes are needed not simply in health care delivery, but in other areas like patient engagement, office infrastructure, and billing and reimbursement. Charles Homer and Richard Baron outline 10 critical elements necessary for such transformation, among them committed leadership, adequate financial resources, active and engaged patients, expert external support, and health information technology.</p>
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<a href="http://www.commonwealthfund.org/~/media/7d4fdd92051c41a28c2f0a779a07817…;
<strong>U.S. Approaches to Physician Payment: The Deconstruction of Primary Care</strong> </a> </strong> <br />"Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well," argue Robert Berenson and Eugene Rich in this article. They say that new, hybrid payment models combining the best features of the standard approaches "will likely be required to restore primary care to its proper role in the U.S. health care system and to promote and sustain the development of patient-centered medical homes."</p>
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<a href="http://www.commonwealthfund.org/~/media/8878474ee2ba4e28b460f1387a5dc3c…;
<strong>How to Buy a Medical Home? Policy Options and Practical Questions</strong> </a> <br />Robert Berenson and Eugene Rich discuss the strengths and weaknesses of a range of payment options to support the PCMH. These include enhanced fee-for-service payment for office visits; paying additional fees for "new" PCMH services; variations of traditional fee-for-service combined with new PCMH-oriented per-patient per-month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services.</p>
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<a href="http://www.commonwealthfund.org/~/media/3b9c19f05c7b449d9fa380aee1015ed…;
<strong>Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home: A Focus on Outcomes</strong> </a> </strong> <br />"Multi-stakeholder involvement will be essential in developing a long-term policy-relevant research agenda" for measuring outcomes of the PCMH model of primary care, conclude the authors of this article. Diane R. Rittenhouse, David H. Thorn, and Julie A. Schmittdiel provide an overview of potential measures of PCMH impact, identify measurement challenges, and recommend areas for further study.</p>
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<a href="http://www.commonwealthfund.org/~/media/1cc1d33c51f041b7b0f9f7d8bcbac00…;
<strong>Defining and Measuring the Patient-Centered Medical Home</strong> </a> </strong> <br />As defined by Kurt C. Stange and colleagues, the PCMH is a team of people committed to improving the health and healing of individuals in a community. Transforming a medical practice into a PCMH, they say, requires a focus on the fundamental tenets of primary care, new ways of organizing care, the development of internal capabilities, and changes in reimbursement. The authors also outline principles for measuring PCMHs.</p>
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<a href="http://www.commonwealthfund.org/~/media/8fde9b34d8834c3cb3e6e1cd7b793a1…;
<strong>Using Evidence to Inform Policy: Developing a Policy Relevant Research Agenda for the Patient-Centered Medical Home</strong> </a>
<br />This editorial by Bruce Landon calls for a research agenda to accompany the implementation of patient-centered medical homes. While previous research has focused on the importance of enhanced primary care, there has been little work to examine the feasibility of implementing the patient-centered medical home in the current U.S. health care system, Landon says.</p>